Association of PD-L1 and p16 expression with clinicopathological parameters in oral cavity and oropharyngeal squamous cell carcinoma.

BACKGROUND: High expression of PD-L1 in tumour cells is associated with a higher response rate to immune checkpoint inhibitors, which target T regulatory pathways. p16 is a surrogate marker for human papilloma virus associated cancers. The present study was conducted to evaluate PD-L1 and p16 expression in head and neck squamous cell carcinomas and its correlation with clinicopathological parameters. MATERIALS AND METHODS: Histologically confirmed cases of head and neck squamous cell carcinomas were evaluated for PD-L1 and p16 expression along with its correlation with grade and site of the tumour. RESULTS: Out of 40 cases, 21 (52.5 %) showed positive immunoreactivity for PD-L1 while 13 (32.5 %) were positive for p16. A significant association was observed between PD-L1 and p16 expression in the oropharynx (p value= 0.035). No significant association could be established between clinicopathological parameters and PD-L1/ p16 expression or between PD-L1 and p16 in the oral cavity. CONCLUSION: PD-L1 expression shows a positive association with p16 in oropharyngeal squamous cell carcinomas. Immune checkpoint inhibitors against PD-L1 can be used in carcinomas with positive expression for PD-L1.

Changing Teaching Trends During Covid-19 And Its Impact On Ent Residency Program In India: A Cross Sectional Study.

Introduction: The COVID-19 pandemic has presented an unmatched challenge to the ENT residency programs to adapt to a form of web-based learning process and stimulation-based training. It also focuses on the mental stress underwent and the viewpoint of the residents to the paradigm shift in clinical care and academics. Methods: An anonymous questionnaire was created in an online survey generator with 22 questions with limited options (yes/no) and was circulated through email and what's app which has been responded to by 240 ENT residents throughout the country. The questionnaire was divided into five sections, demographics, knowledge about COVID-19 and its management, impact on clinical activity, academics and mental well-being section. Results: Out of 240 respondents, 190(79.2%) were junior residents and 50(20.8%) were senior residents. Although many of them knew the necessary precautions to be taken, 94(39.8%) turned out to be positive themselves with the high fear of transmitting to their family members. Three-fourth participants suggested extending the training period after graduation for the loss incurred. However, half of them sought an opportunity to train themselves for the management of communicable disease, 95% of the residents opined that they are having a negative impact on the job performance due to loss of surgical hands-on which has been drastically reduced. Conclusion: The issues mentioned have been addressed through STEPs - Safety of the residents, Time utilisation by research, Education continuation by online web learning and stimulatory programs, psychological support for mental well-being. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-022-03377-7.

The Role of Nasal Endoscopy in the Management of Rhinosinogenic Headache.

Nasal endoscopy is one of the common out-patient diagnostic procedures in ENT practice. Patients suffering from persistent rhinosinogenic headache which is not responding to standard medical management demand a thorough evaluation that incorporates diagnostic nasal endoscopy (DNE). Rhinosinogenic headache is multifactorial which includes contact point, deviated nasal septum, inferior turbinate hypertrophy, nasal polyposis and sinusitis. To identify the particular cause of the headache is necessary for appropriate management. We conducted a prospective observational study to assess the role of nasal endocopy in diagnosis and management of rhinosinogenic headache persisting for at least 3 months, over a period of one and half year. Thirty patients fulfilling the inclusion criteria were enrolled in the study. We categorized the headache as mild, moderate and severe. After DNE, we found that 93.33% (n = 28) had deviated nasal septum (DNS), 40% (n = 12) had septal spur, 10% (n = 3) had polyp, 50% (n = 15) had contact point, 67% (n = 20) had inferior turbinate hypertrophy (ITH), 26.67% (n = 8) had pneumatised middle turbinate or concha bullosa and 50% (n = 15) patients of sinusitis. After computed tomographic evaluation, 30% (n = 9) patients underwent septoplasty, 20% (n = 6) underwent endoseptoplasty, 40% (n = 12) underwent middle turbinate lateralisation (MTL), 16.67% (n = 5) underwent FESS, 30% (n = 9) underwent FESS with endoseptoplasty, 3.33% (n = 1) Caldwell Luc's operation for unilateral maxillary polyp with sinusitis. Postoperatively we found that, 86.67% (n = 26) had total relief, 6.67% (n = 2) had partial improvement and 6.67% (n = 2) had no improvement of headache. Our study demonstrates that nasal endoscopy has significant role in diagnosis and management of rhinosinogenic headache.

The Maxillary Swing: An Efficacious Approach to Surgical Management of Advanced Stage Juvenile Nasopharyngeal Angiofibroma.

The objective of this study was to evaluate the efficacy and outcome using the maxillary swing approach for the management of extensive nasopharyngeal angiofibroma. A retrospective case series analysis in a tertiary care centre revealed eighteen cases with extensive nasal angiofibroma operated using the maxillary swing approach between 2011 and 2017. All patients had tumour extension to the lateral most portions of the infratemporal fossa with complete occupation and destruction of the lateral wall of the sphenoid sinus causing abutment to the cavernous sinus and complete involvement of the pterygopalatine fossa and pterygoid base. One patient displayed full occupancy of the maxillary sinus as a consequence of erosion of the posterior and medial walls of the maxillary sinus. All patients underwent tumour excision using the maxillary swing approach. Patients were followed up for a minimum period of 1 year after surgery. The maxillary swing approach gave optimal exposure of the entire central skull base including the infratemporal fossa and its extreme lateral and superior aspects. Adequate tumour exposure and vascular control could be achieved in all cases resulting in complete tumour excision. The mean operative time was 3 h 15 min. Post-operative healing was satisfactory with palatal fistula formation in four cases and all patients remaining disease-free up to the present time. One had minimal misalignment of the halves of the upper jaw and two had epiphora, of which one required dacryocystorhinostomy. The maxillary swing is an effective approach in the management of extensive nasopharyngeal angiofibroma and leads to optimal anatomical exposure with minimal morbidity.

Wave of Invasive Fungal Disease on the Shores of COVID-19: A Case Series of COVID-19 Associated Rhino-Orbital Fungal Rhinosinusitis and Literature Review.

Coronavirus disease 2019 (COVID-19) may be associated with a wide range of bacterial and fungal co-infections. Acute invasive fungal sinusitis is an aggressive infection affecting immunocompromised patients and high mortality rate. Here, in this case series, we have reviewed three cases of COVID-19 associated rhino-orbital invasive fungal disease. Patients with COVID-19 associated pneumonia with diabetes mellitus are at an increased risk of developing invasive pulmonary fungal infections probably due to their reduced immunological competence. Concurrent glucocorticoid therapy probably heightens the risk of mucormycosis. Physicians should be aware of and should have high index of suspicion of possible fungal infection in post COVID-19 patients. Aggressive management both medical and surgical, is required to improve outcomes of secondary invasive fungal infections in patients with COVID-19 infection. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-022-03213-y.

Mammary Analogue Secretory Carcinoma of Submandibular Gland: A Case Report with Review of the Literature.

Secretory carcinoma (SC) is a rare salivary gland tumor and has been recently included in the fourth edition of the World Health Organization classification of head and neck tumors. To understand the histopathologic findings and clinical behavior of mammary analogue secretory carcinoma (MASC) of the submandibular gland in a 23 year old female. MASC is an intriguing and rare malignant salivary gland tumor first described in 2010. It shares histologic, immunohistochemical and genetic features with secretory carcinoma of the breast. The clinical behavior of MASC ranges from slowly growing tumors to aggressive tumors that can cause widespread metastasis. Many cases of MASC were discovered in archived cases previously classified as pleomorphic adenoma, acinic cell carcinoma, mucoepidermoid carcinoma, and adenocarcinoma. They are only a few reported in submandibular gland. MASC is a newly recognized variant of salivary gland malignancy. Further research is needed to better delineate its overall prevalence and to define an appropriate treatment algorithm for this new clinical entity.

Massive Angiomatous Nasal Polyp Mimicking Nasopharyngeal Angiofibroma.

Angiomatous Nasal polyps is the rarest entity amongst the various types of nasal polyps known. It presents as mass filling the nasal cavity with extensions into surrounding structures; patients often presenting with symptoms of nasal obstruction and epistaxis, thus, mimicking nasal angiofibromas or malignancies. Here, we present a case of 16-year-old male, with complaints of unilateral nasal obstruction, intermittent epistaxis, anosmia, headache, ipsilateral epiphora and facial swelling. Further examination and investigations favoured a diagnosis of an angiomatous polyp with extension into surrounding structures. Surgical excision was carried out. Histopathological studies on the excised specimen were in line with the preoperative diagnosis. The patient remains disease free at a follow of 1 year.

Solitary Langerhans cell histiocytosis of the hard palate: a diagnostic pitfall.

Langerhans cell histiocytosis (LCH) is a relatively rare and unique disease characterized by an abnormal proliferation of immature dendritic cells. It is predominantly seen in children with adults showing less than ten times the incidence compared to childhood. The clinical presentation and organ involvement is highly variable. Oral manifestations generally consist of mucosal ulceration associated with lesions of the underlying bone. Lesions limited to the oral mucosa are rare. We present a case of a 45-year-old male who presented with an ulcer on the hard palate showing histopathologic features of LCH. The present case is a reminder of the possibility of occurrence of this unusual entity in the oral cavity. Appropriate use of immunohistochemistry is advocated to avoid diagnostic pitfalls.

Primary tuberculosis of the cheek: a common disease with a rare presentation.

Tuberculosis of the extra-oral region is uncommon and is rarely primary. Extra-oral involvement of the cheek in the absence of tuberculosis elsewhere in the body is rare. To the best of our knowledge, we report here the first case of primary tuberculosis of the cheek in a 31-year-old male presenting as a nodular swelling of the cheek. Previous reported cases of extra-oral involvement of the cheek involved either fistula or sinus of the cheek. Excisional biopsy for tissue diagnosis and bacterial examination with culture should be performed for an early diagnosis as a delay in treatment can lead to devastating consequences.

Schwannoma of the palatine tonsil.

Schwannomas can originate in any peripheral, autonomic, or cranial nerve except the olfactory and optic nerves. Between 25 and 48% of all schwannomas have been reported to arise in the head and neck, with the acoustic nerve being the most common site of origin there. Schwannomas of the palatine tonsil are rare; as far as we know, only 6 such cases have been previously reported in the literature; 5 of these 6 occurred in adults and the other in an adolescent. We report a new case in a 42-year-old woman, which was diagnosed on the basis of histopathology.

Giant presentation of pleomorphic adenoma in major salivary gland.

Pleomorphic adenoma (PA) is the most common benign salivary gland tumour, accounting for as many as 80% of all such tumours. Although PA most commonly occurs in the parotid gland (85% cases), it may involve submandibular (8%), lingual and minor salivary glands. It is a benign tumour with a slow and continuous growth and without treatment can assume enormous dimensions. This paper describes a giant PA's arising in the submandibular gland and treated by complete surgical excision without sequel. In our case, a male patient presented with a tumour history of more than 4 years and weight of the resected mass was 2.24 kg. Giant PA's of the submandibular gland are very rare in medical literature.

Bilateral complete choanal atresia in an adult woman--managed with nasal endoscopes.

Choanal atresia usually presents at birth as respiratory distress and difficulty in feeding. Unilateral choanal atresia is sometimes missed during childhood but bilateral choanal atresia present in a newborn as a medical emergency and if immediate measures are not taken to relieve obstruction, it may result in death of the child. There are very few cases in literature where bilateral choanal atresia was detected in an adult as a chance finding or in a patient complaining of nasal obstruction, speech problem or sinusitis. Here a case of an adult female is reported who presented as a case of bilateral pansinusitis but was later found to have bilateral complete choanal atresia. Nasal endoscopes were used for surgical repair of choanal atresia.

Tuberculosis of paranasal sinuses.

Nasal tuberculosis is very rare but much rarer is tuberculosis of paranasal sinuses. It involves especially the maxillary sinus and is usually unilateral. We report an unusual case of tuberculosis of frontal and maxillary sinus in a 68 years old male, who presented with a swelling above left medial canthus, with no other eye or nasal complaints. Clinical and radiological findings on our initial evaluation suggested that the patient had left frontal mucocoele with bilateral maxillary haziness. Diagnosis was established on FNAC report and subsequent Ziehl - Neelsen staining of nasal swabs and tuberculin skin test. Later chest x-ray examination was suggestive of pulmonary tuberculosis, which was the primary cause. Patient responded well to antituberculosis drug therapy.

Two cases of neurilemmoma of the tongue.

Neurilemmomas of the tongue are uncommon. When they do occur; treatment is simple. However; diagnosis is invariably delayed because of the vagueness of symptoms. We encountered 2 cases of this unusual tumor within weeks of each other In 1 of these cases, the definitive diagnosis was delayed because of the atypical clinical picture-that is, an abscess in the tongue that had caused respiratory distress. We describe our management of these 2 cases, and we discuss what has been published in the literature regarding the presentation, diagnosis, histopathology, treatment, and prognosis for patients with glossal neurilemmoma.

Comparison of the efficacy of clinical examination, ultrasound neck and computed tomography in detection and staging of cervical lymph node metastasis in head and neck cancers.

There are many modalities, which are being used for detection of cervical lymph nodes in head and neck cancers clinical examination, computed tomography, ultrasound, magnetic resonance imaging and radionuclide scintigraphy. Various studies in past have highlighted their benefits and drawbacks used singly or in comparison with others. Here we present the study of 100 patients comparing the result of clinical examination, computed tomography and ultrasound.

External rhinoplasty for dorsum swellings.

As any swelling over dorsum nose is cosmetically unacceptable so is the post-operative scar. The external rhinoplasty approach proceeds in the natural tissue dissection planes in the nose, thus ensuring minimal bleeding, improved exposure and good healing with minimal scar formation. We present cases of three different swellings due to rhinophyma, dermoid cyst and a rare interesting foreign body all dealt with external rhinoplasty approach with good results.

Primary thyroid tuberculosis.

In India, it is estimated that more than 40% of the adults are infected with tuberculosis bacilli and every year 2 million people develop tuberculosis and nearly 500,000 die from it1. But, tuberculosis of the thyroid gland occurs only rarely. Since extra-pulmonary tuberculosis is now seen relatively more frequently, the existence of this condition should be recognized when goitres are being treated. We present a case of right thyroid nodule associated with low grade fever and weight loss. No signs and symptoms of hypothyroidism or hyperthyroidism were present. Patient did not have any other tuberculosis focus. Routine investigation and chest X-ray were normal. Sputum for Acid Fast Bacilli was negative. Fine Needle Aspiration Cytology and Contrast Enhanced Computed Tomography led to a diagnosis of Primary Thyroid Tuberculosis in a euthyroid patient. Patient responded well to Anti tubercular Drug Therapy along with repeated aspiration.

Teratoma tongue: Case report and review of literature.

Teratomas are true neoplasms composed of tissues from all three germinal layers and may exhibit variable levels of maturity. They have an unknown origin and eccentric microscopic appearance. Teratomas arising from the oral cavity are rare in the newborn; only 22 cases have been reported in the literature. We describe a female neonate with an oral teratoma originating from the tongue that was successfully treated with surgery.